CEN-Certified Emergency Nurse Exam 2026/2027 |
Complete Questions And Answers (Verified Answers) |
Exam Prep | Comprehensive Exam Guide 2026&2027
1. A patient arrives in the emergency department after a high-speed motor vehicle collision.
The patient has severe facial trauma, gurgling respirations, and an oxygen saturation of
82%. Which intervention should the nurse prioritize?
A. Insert a nasogastric tube
B. Establish two large-bore IV lines
C. Perform immediate airway management while maintaining cervical spine precautions
D. Obtain a portable chest radiograph
Answer: C
The gurgling respirations and severe hypoxemia indicate an immediately threatened airway.
Airway management takes priority while cervical spine protection is maintained because the
mechanism suggests possible cervical injury.
2. A patient with suspected septic shock has a blood pressure of 78/42 mmHg, altered
mental status, cool extremities, and elevated serum lactate. Which intervention is most
appropriate initially?
A. Begin rapid isotonic crystalloid administration
B. Administer a loop diuretic
C. Restrict oral and IV fluids
D. Place the patient in a sitting position
Answer: A
Initial management of septic shock includes prompt IV crystalloid resuscitation to improve
circulating volume and tissue perfusion. Vasopressors are generally added when hypotension
persists despite appropriate fluid resuscitation.
3. A patient presents with crushing substernal chest pain, diaphoresis, and nausea. Which
diagnostic test should the emergency nurse prioritize?
A. D-dimer
B. 12-lead ECG
C. Abdominal ultrasound
D. Urinalysis
Answer: B
,A 12-lead ECG is a priority in suspected acute coronary syndrome because it rapidly identifies
ischemic changes and possible STEMI requiring immediate reperfusion therapy.
4. A patient with severe asthma becomes increasingly fatigued. Breath sounds are now
markedly diminished, and the patient is becoming somnolent. What does this finding most
strongly indicate?
A. Clinical improvement
B. Resolution of bronchospasm
C. Anxiety-related hyperventilation
D. Impending respiratory failure
Answer: D
A progressively quiet chest in a severely ill asthma patient can indicate critically reduced
airflow rather than improvement. Fatigue and altered mental status further suggest
impending respiratory failure.
5. A patient with diabetic ketoacidosis has a serum potassium of 2.9 mEq/L. Which
intervention should the nurse anticipate before initiating an insulin infusion?
A. Sodium bicarbonate administration
B. Potassium replacement
C. Fluid restriction
D. Calcium chloride administration
Answer: B
Insulin shifts potassium intracellularly and can worsen hypokalemia. Significant hypokalemia
must therefore be corrected before insulin therapy is initiated.
6. A patient with an acute ischemic stroke develops sudden worsening neurologic deficits
while being evaluated. Which action is most appropriate?
A. Delay evaluation until symptoms stabilize
B. Administer oral fluids
C. Activate the facility's acute stroke response pathway
D. Encourage ambulation
Answer: C
Sudden neurologic deterioration requires immediate reassessment and activation of the
stroke response process because time-sensitive interventions may be available.
7. A patient develops facial swelling, wheezing, hypotension, and generalized urticaria
minutes after receiving an antibiotic. Which medication should the nurse administer first?
,A. IV diphenhydramine
B. IM epinephrine
C. IV famotidine
D. Nebulized saline
Answer: B
Epinephrine is the first-line treatment for anaphylaxis because it rapidly addresses airway
edema, bronchospasm, and cardiovascular compromise.
8. A trauma patient has absent breath sounds on the left, severe respiratory distress,
hypotension, and tracheal deviation. Which condition should the nurse suspect?
A. Simple pneumothorax
B. Pulmonary contusion
C. Hemothorax
D. Tension pneumothorax
Answer: D
The combination of severe respiratory distress, unilateral absent breath sounds, hypotension,
and tracheal deviation is characteristic of tension pneumothorax, an immediately life-
threatening condition requiring emergency decompression.
9. A patient with suspected opioid overdose has a respiratory rate of 6/min and pinpoint
pupils. Which assessment is the immediate priority?
A. Airway and ventilation
B. Bowel sounds
C. Skin turgor
D. Peripheral edema
Answer: A
Opioid toxicity can cause life-threatening respiratory depression. The nurse must immediately
assess and support airway and ventilation while preparing for naloxone administration.
10. A patient presents with severe headache described as "the worst headache of my life,"
followed by vomiting and neck stiffness. Which condition should the nurse suspect?
A. Tension headache
B. Migraine without complications
C. Subarachnoid hemorrhage
D. Sinusitis
Answer: C
, A sudden, severe thunderclap headache accompanied by vomiting and meningeal findings is
highly concerning for subarachnoid hemorrhage and requires emergent evaluation.
11. A patient with suspected gastrointestinal hemorrhage is pale, tachycardic, and
hypotensive. Which nursing action has the highest priority?
A. Offer clear liquids
B. Establish large-bore IV access
C. Place the patient in a warm shower
D. Obtain a stool culture
Answer: B
Large-bore IV access permits rapid administration of crystalloid, blood products, and
medications during significant hemorrhage.
12. A patient with hyperkalemia develops peaked T waves on the ECG. Which medication
should the nurse anticipate administering to stabilize the cardiac membrane?
A. IV calcium
B. Oral potassium
C. Furosemide only
D. Sodium chloride tablets
Answer: A
IV calcium stabilizes the myocardial cell membrane and reduces the immediate risk of
dysrhythmia from severe hyperkalemia. It does not remove potassium from the body.
13. A patient with a suspected cervical spine injury reports numbness and weakness after a
fall. Which action is appropriate?
A. Encourage neck movement to assess range of motion
B. Remove the cervical immobilization device
C. Maintain spinal precautions and perform neurologic assessment
D. Place the patient prone
Answer: C
Until spinal injury is excluded, spinal precautions should be maintained. Serial neurologic
assessment helps identify evolving spinal cord compromise.
14. A patient with acute pulmonary edema is severely dyspneic and producing pink, frothy
sputum. Which positioning is most appropriate?
Complete Questions And Answers (Verified Answers) |
Exam Prep | Comprehensive Exam Guide 2026&2027
1. A patient arrives in the emergency department after a high-speed motor vehicle collision.
The patient has severe facial trauma, gurgling respirations, and an oxygen saturation of
82%. Which intervention should the nurse prioritize?
A. Insert a nasogastric tube
B. Establish two large-bore IV lines
C. Perform immediate airway management while maintaining cervical spine precautions
D. Obtain a portable chest radiograph
Answer: C
The gurgling respirations and severe hypoxemia indicate an immediately threatened airway.
Airway management takes priority while cervical spine protection is maintained because the
mechanism suggests possible cervical injury.
2. A patient with suspected septic shock has a blood pressure of 78/42 mmHg, altered
mental status, cool extremities, and elevated serum lactate. Which intervention is most
appropriate initially?
A. Begin rapid isotonic crystalloid administration
B. Administer a loop diuretic
C. Restrict oral and IV fluids
D. Place the patient in a sitting position
Answer: A
Initial management of septic shock includes prompt IV crystalloid resuscitation to improve
circulating volume and tissue perfusion. Vasopressors are generally added when hypotension
persists despite appropriate fluid resuscitation.
3. A patient presents with crushing substernal chest pain, diaphoresis, and nausea. Which
diagnostic test should the emergency nurse prioritize?
A. D-dimer
B. 12-lead ECG
C. Abdominal ultrasound
D. Urinalysis
Answer: B
,A 12-lead ECG is a priority in suspected acute coronary syndrome because it rapidly identifies
ischemic changes and possible STEMI requiring immediate reperfusion therapy.
4. A patient with severe asthma becomes increasingly fatigued. Breath sounds are now
markedly diminished, and the patient is becoming somnolent. What does this finding most
strongly indicate?
A. Clinical improvement
B. Resolution of bronchospasm
C. Anxiety-related hyperventilation
D. Impending respiratory failure
Answer: D
A progressively quiet chest in a severely ill asthma patient can indicate critically reduced
airflow rather than improvement. Fatigue and altered mental status further suggest
impending respiratory failure.
5. A patient with diabetic ketoacidosis has a serum potassium of 2.9 mEq/L. Which
intervention should the nurse anticipate before initiating an insulin infusion?
A. Sodium bicarbonate administration
B. Potassium replacement
C. Fluid restriction
D. Calcium chloride administration
Answer: B
Insulin shifts potassium intracellularly and can worsen hypokalemia. Significant hypokalemia
must therefore be corrected before insulin therapy is initiated.
6. A patient with an acute ischemic stroke develops sudden worsening neurologic deficits
while being evaluated. Which action is most appropriate?
A. Delay evaluation until symptoms stabilize
B. Administer oral fluids
C. Activate the facility's acute stroke response pathway
D. Encourage ambulation
Answer: C
Sudden neurologic deterioration requires immediate reassessment and activation of the
stroke response process because time-sensitive interventions may be available.
7. A patient develops facial swelling, wheezing, hypotension, and generalized urticaria
minutes after receiving an antibiotic. Which medication should the nurse administer first?
,A. IV diphenhydramine
B. IM epinephrine
C. IV famotidine
D. Nebulized saline
Answer: B
Epinephrine is the first-line treatment for anaphylaxis because it rapidly addresses airway
edema, bronchospasm, and cardiovascular compromise.
8. A trauma patient has absent breath sounds on the left, severe respiratory distress,
hypotension, and tracheal deviation. Which condition should the nurse suspect?
A. Simple pneumothorax
B. Pulmonary contusion
C. Hemothorax
D. Tension pneumothorax
Answer: D
The combination of severe respiratory distress, unilateral absent breath sounds, hypotension,
and tracheal deviation is characteristic of tension pneumothorax, an immediately life-
threatening condition requiring emergency decompression.
9. A patient with suspected opioid overdose has a respiratory rate of 6/min and pinpoint
pupils. Which assessment is the immediate priority?
A. Airway and ventilation
B. Bowel sounds
C. Skin turgor
D. Peripheral edema
Answer: A
Opioid toxicity can cause life-threatening respiratory depression. The nurse must immediately
assess and support airway and ventilation while preparing for naloxone administration.
10. A patient presents with severe headache described as "the worst headache of my life,"
followed by vomiting and neck stiffness. Which condition should the nurse suspect?
A. Tension headache
B. Migraine without complications
C. Subarachnoid hemorrhage
D. Sinusitis
Answer: C
, A sudden, severe thunderclap headache accompanied by vomiting and meningeal findings is
highly concerning for subarachnoid hemorrhage and requires emergent evaluation.
11. A patient with suspected gastrointestinal hemorrhage is pale, tachycardic, and
hypotensive. Which nursing action has the highest priority?
A. Offer clear liquids
B. Establish large-bore IV access
C. Place the patient in a warm shower
D. Obtain a stool culture
Answer: B
Large-bore IV access permits rapid administration of crystalloid, blood products, and
medications during significant hemorrhage.
12. A patient with hyperkalemia develops peaked T waves on the ECG. Which medication
should the nurse anticipate administering to stabilize the cardiac membrane?
A. IV calcium
B. Oral potassium
C. Furosemide only
D. Sodium chloride tablets
Answer: A
IV calcium stabilizes the myocardial cell membrane and reduces the immediate risk of
dysrhythmia from severe hyperkalemia. It does not remove potassium from the body.
13. A patient with a suspected cervical spine injury reports numbness and weakness after a
fall. Which action is appropriate?
A. Encourage neck movement to assess range of motion
B. Remove the cervical immobilization device
C. Maintain spinal precautions and perform neurologic assessment
D. Place the patient prone
Answer: C
Until spinal injury is excluded, spinal precautions should be maintained. Serial neurologic
assessment helps identify evolving spinal cord compromise.
14. A patient with acute pulmonary edema is severely dyspneic and producing pink, frothy
sputum. Which positioning is most appropriate?
